公立医院规模扩张的公共经济学解释与对策  

Scale expansion of public hospitals: Economics explanation and measures

作　　者：董四平[1,2] 李冰[2] 杨婷婷[1] 隋霞[1] 何柳[2] 沈晓[2] 

机构地区：[1]卫生部医院管理研究所,北京100191 [2]武汉大学政治与公共管理学院,湖北武汉430072

出　　处：《中国卫生政策研究》2013年第9期36-40,共5页Chinese Journal of Health Policy

基　　金：卫生部医院管理研究所基金(201101)

摘　　要：我国公立医院床位规模盲目扩张存在诸多风险与弊端。本文在分析医院规模扩张一般原因的基础上,基于尼斯卡宁模型构建了公立医院规模发展的公共经济学解释模型:医院追求的供给量是医院总成本与总收益相当时所对应的产量和规模,而不是医院边际收入等于边际成本时所对应的最佳产量和最佳规模;医院追求的规模一般为最佳规模的两倍。最后提出了遏制公立医院盲目扩张的对策和建议,包括消除公立医院管理的内部性、利用医保政策引导医院集约式经营、实现医疗机构设置规划的硬约束和合理引导医疗需求向基层流动等。The abnormal expansion of the number of beds in public hospitals in China has many risks and drawbacks. An economic interpretation model of the expansion was established referring to Niskanen model besides the reasonable clauses. The scale of hospital beds is decided by a hospitalg total revenue rather than optimal supply and size when the hospital＇ s marginal revenue equals marginal cost. The desired scale is generally twice that of the optimum size. This paper is intended to propose some recommendation to curb the abnormal expansion of public hos- pitals, including eliminating public hospitals＇ ＂internality,＂ re-orientating hospital operating focus away from health insurance policies, creating strict requirements for hospital planning, and establishing reasonable paths that guide medical need.flows to primary hospitals.

关 键 词：公立医院 规模扩张 尼斯卡宁模型 公共经济学 

分 类 号：R197.3[医药卫生—卫生事业管理]